- [Rhonda]: Are you familiar with some of the gene polymorphisms, the snps in...
There’s one gene that, I think it’s NPAS2, I think, that is involved in circadian rhythm,
but also there is susceptibility to bipolar disorder when it’s dis-regulated.
So again, sort of this...
- [Charles]: Yes.
Well, especially bipolar disorder.
You know, if depression, if regular depression is sort of an evolved human response to the
adversity of a relationship, bipolar disorder is a response to the adversity of time.
- [Rhonda]: What do you mean by that?
- [Charles]: Well, what you see with bipolar disorder is that the many, so folks with bipolar
disorder are also, they can be set off into either manias or depressions by stress, right?
But they’re also exquisitely sensitive to fluctuations in circadian patterns.
So the great way to induce a manic episode is to just keep people awake.
There’s wonderful data from the 1980s from the National Institute of Mental Health where
they’d keep really very ill bipolar patients in psychiatric wards for years and study every,
you know, every episode.
And always, depressive but especially, manic episodes would be triggered by a night of
sleep deprivation.
You see this clinically.
So time is an adversity because it’s, you know, it’s constantly threatening homeostasis.
So, you know, the things we’re talking about, the sun comes up, the sun goes down, this
happens, that happened, this happened, and your body went up and down.
Any time things move, there’s always a risk of things coming off the rails and breaking,
right?
So bipolar folks are so profoundly vulnerable to disruptions in their circadian sleep/wake
cycles, in their activity cycles.
Helen Frank was one of the originators of this, called “Chronotherapy.”
It came out of University of Pittsburgh, where they actually, you know, as a therapeutic
thing for bipolar sort of, part of it was education about, you always go to sleep at
the same time, you get up at the same time.
You know, be careful about air travel.
There is a beautiful study from Heathrow showing that, you know, that there’s a hugely increased
risk of people showing up at Heathrow with a psychotic mania if they come from America
to Heathrow, than if they come from Asia to Heathrow.
And the reason is because it’s a sleep deprivation thing if you’re coming from here, that’s
why you’re always exhausted when you land in Europe.
You’ve missed a night of sleep.
Oh, so many manic patients I saw in my years running the emergency psychiatry at UCLA.
Many of them were activated by getting on a plane.
- [Rhonda]: Wow.
- [Charles]: “I was normal till I got on the plane.
I got off the plane, and the world looked different.”
And then they’re off and gone.
- [Rhonda]: That’s what patients would say?
- [Charles]: Oh, yeah.
- [Rhonda]: Wow.
- [Charles]: And the first episodes were often induced.
I mean, people really developed life-long psychotic disorders in response to...
- [Rhonda]: Do you think those people that are having that are a little more sensitive
to the, like their circadian, they maybe have some snp and...?
- [Charles]: Yeah, that’s probably NPAS, which is one of the great kind of drivers
or regulators of the circadian things, is a particular bipolar disorders, because, you
know, it’s a condition where time, the changes of time, the recurrent changes of time are
just a big stressor for that disorder.
- [Rhonda]: Yeah.
And probably lots of genes are not being regulated properly, right?
- [Charles]: That’s right.
- [Rhonda]: And it’s like a transcription factor, regulating a whole host of genes,
and so their response to things are very different because they’re not activating all those
pathways that you’re supposed to activate, you know?
- [Charles]: Yeah.
Whereas, you know, it’s interesting is, if you don’t have that bipolar risk, most
of us do not end up in the psych hospital because we missed a night of sleep, right?
- [Rhonda]: Yeah, right.
- [Charles]: We end up in a psych hospital because the person we cared about dumped us,
or somebody died, or we lost, or we were shamed, or...
You know, it’s just the things, when something tees it off, it’s a different register of
things that tee it off.
Which is so interesting, it’s one of the main differences between...
- [Rhonda]: When I’m missing out in sleep, like if I’m traveling abroad, I certainly
feel strange when I land in Heathrow, or any other airport in Europe, or even Asia.
But I certainly don’t feel...
- [Charles]: You’re not.
- [Rhonda]: Yeah.
It feels kind of weird.
- [Charles]: Right.
But you’re not psychotic.
- [Rhonda]: No.
I don’t actually have that snp so.